Laserfiche WebLink
FOR.OFFICE�USE: <br /> ------------------- -- --------------------------------- <br /> ----------------------------------------- <br /> APPLICATION FOR SANITATION PERMIT Permit No. ..1 YfIr <br /> k a I <br /> - ------------- --_-------- --- --------- Duplicate) <br /> --- --- --------- -- -------------------------------- Date Issued <br /> - ------------- (Complete ' Date Issued -�- � <br /> . p In •� <br /> This Permit Expires 1 Year From <br /> Application is hereby made to the San Joaquin.Local Health District for a permit to construct and in II the work herein described, <br /> This application ism a in compliance with County Ordinance Nq, 5� <br /> JOB ADDRESS L - /�/,7, <br /> -- - ---------- . ----- <br /> Owner's Name ---------- _1 - Phon <br /> -6 <br /> Addresst ------------- --------- ---- -- ------------------------------------------------- --------­---- <br /> Contractor's Name---------------- •--- '.-. (Jy {-------- - ---------`----------------------- Phone----------------------------------- <br /> Installation will serve: Residenceartment Commercial <br /> C�p ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---L Number of bedrooms �,iate <br /> ,t tcj <br /> umber of baths __l___ Lot size <br /> - ------------------- <br /> Water Supply: PuHic`system ❑ Community system ❑ Depth to W er Table ________ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ ay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes, ---date-----------_-------) No ❑ New Construction; Yes No ElFHA/VA: Yes 7] No E] a <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> " <br /> (No-septic;-tank-or cesspool-permitted-if pubii sewer-is availa6le-within=200 feet: -r -- # <br /> / b <br /> Septic Tank: Distance from nearest well__ ___________Distance from fou atj�n____[ ____.__Material-___ <br /> [� No. of compartments.___�----____.___Size_4/_�.� �&7''Liquid depth__-_,S772_`1__....-_Capacity__f� <br /> DisposalF' d: Distance from nearest well_________________Distance from foundation____� ___---.Disfiance to nearest la line__ <br /> Number of lines_--- ------------- ____Length of each line_S0f__30_1_.3V-Width of trenck,1 ll <br /> [ �i . -- I------------- <br /> Type of filter material _ _ _____)___Depth of filter material----.__I-q____.__._Total length------------I1 0---_________-____ <br /> Seepage Pit: Distance to nearest well.-._______________)____Distance from foundation___________________.Distance to nearest lot line_--.---__________ <br /> ❑ Number of pits-- ------•--_-._.____Lining material---------- ------------Size: Diameter----_----_----.- ----Depth------------.----- -----___--- <br /> Cesspool: Distance from nearest well_________________Distance from foundation._.__._.__-.--------Lining material___.___._..__----_--_______-___.__. <br /> ❑ Size: Diameter_-+---------------- - ---------De th--------------------------- --- - - - -------------.Liquid Capacity- --- ---------------gals. 6- <br /> Privy: <br /> Privy: Distance from nearest well______-_._------ _______________________________Distance from nearest building____...-______--------__________---__-. <br /> ❑ Distance to nearest lot line- ---------- ---_-----_----- --------------------------------- <br /> Remodeling <br /> -------------------------------Remodeling and/or repairing (describe}:_ ------ _--_-- -----------------------------•------------------------------------------------------ <br /> --------------------------------------------------------------- <br /> - --------------------------------------------------------------------------•---------•---------------------------------------•-------------------------------- <br /> -------------------------------.------------------------•- ------------------------------------------- ----------------------------------------------•----------------------------------------------- ------------- - <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, St e w , nd rules regulations of the San Joa uin Local Health District. <br /> rAL <br /> E <br /> (Signed)_ <br /> ' ( t�- ---�- 3 ' -------- - ---- -- ------------------- r►iT ntraet <br /> - <br /> - - --- <br /> --- ------------ <br /> (Piot plan, showing size of lot, location of system in relati o wells, buildin s, etc., can be placed on reverse side). <br /> ( FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.----- >r t ���-'- --- --------------------------------------------------------------- DATE.- - <br /> REVIEWEDBY-------------------------------------- ---------------------------------------- -------------------------------------------- DATE----- ------------------------------------------------------ <br /> BUILDING PERMIT ISSUED----------------------------------- -------------------------------------------- ------------- -- -- DATE <br /> ------------------------------------- <br /> Alterations and/or recommendations--- --- -------- ------------------------------------------..------------------------------------- <br /> ----------------- --------------------------------------------------- ------- ------ --- ------ ------- ----------------------------------------------------•--••----------------------•------------------------------- <br /> --------------------------------------------------------------------------- --------- ---- ------------------------------------- ---------•----- -------_----_----- -----•----_---------- --------------------------- <br /> -------------------- ------------------- ------ -- ------- ------ 1.-------------------- _-- ---------------------------------------------------------------------------------------------- <br /> - / - - -- --- ------- ------------ <br /> FINAL fNSP ION BQ Date. <br /> . - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street' <br /> Stockton,California Lodi,California Manteca,California Tracy, California y <br /> _ I <br />